Instrument for use in coniotomy

ABSTRACT

A coniotomy instrument comprising a speculum portion and a knife unit the knife of which passes through the speculum portion and is adapted on application of the instrument to be advanced in such a manner that the knife point protrudes from the fore end of the speculum portion to facilitate penetration and which, after application of the instrument, is retractable to leave a free passage for air flow through the speculum portion. The speculum portion comprises two separable specula blades, each at a fore end of two tongs legs, and the knife unit comprises a U-shaped portion with two resilient U-shaped legs which slidably engage over the speculum portion and a knife blade which is centrally located between the U-shaped legs and extends through the speculum portion.

[ 1] 3,893,454 July 8, 1975 INSTRUMENT FOR USE IN CONIOTOMY [75] Inventor: Karl Wilhelm Hagelin, Backvagen,

Sweden [73] Assignee: Aktiebolaget Stille-Werner,

Stockholm, Sweden [22] Filed: Feb. 6, 1974 [21] Appl. No.: 440,121

OTHER PUBLlCATlONS Salvatore, J. 15 A New Rapid Tracheotomy Instrument", in J.A.M.A. 16516: 20772078, 1957.

Primary ExaminerChanning L. Pace Attorney, Agent, or Firm-l-lill, Gross, Simpson, Van Santen, Steadman, Chiara & Simpson 5 7] ABSTRACT A coniotomy instrument comprising a speculum portion and a knife unit the knife of which passes through the speculum portion and is adapted on application of the instrument to be advanced in such a manner that the knife point protrudes from the fore end of the speculum portion to facilitate penetration and which, after application of the instrument, is retractable to leave a free passage for air flow through the speculum portion. The speculum portion comprises two separable specula blades, each at a fore end of two tongs legs, and the knife unit comprises a U-shaped portion with two resilient U-shaped legs which slidably engage over the speculum portion and a knife blade which is centrally located between the U-shaped legs and extends through the speculum portion.

8 Claims, 7 Drawing Figures PATHJTEDHL 8 1975 ,893,454

sum 2 dMQHYFDJUL mars SHEET 1 INSTRUMENT FOR USE IN CONIOTOMY BACKGROUND OF THE INVENTION Tracheotomy and coniotomy are steps which can be taken in order to release an obstruction in the airpassages of vertebrates, e.g. steps which can be taken to relieve situations of such a complicated nature as to render it insufficient merely to arrange the patient in a position to permit draining of the obstruction through the patients mouth, to cleanse the mouth cavity of the patient and to move the patients tongue forward, and with which it is impossible to effect endotracheal intubation, which involves the insertion of a pharynx tube and an endotracheal tube through the mouth.

Tracheotomy is a surgical remedy, in which an opening is made through the wall of the trachea and the soft portions of the larynx at a position located a few cartilages beneath the thyroid cartilage. This form of surgery is to be preferred when the opening is to remain for more than I or 2 days; the opening may in fact be left for many years, for example in the respiratory treatment of patients suffering from poliomyelities(sic) or in the treatment of patients who have been operated upon for cancer of the throat. Such surgery requires trained operators, assistants, special instruments, and should not be carried out when pressed for time.

In the event of acute air-passage obstruction when prevailing conditions do not permit endotracheal intubation or tracheotomy, coniotomy is performed instead, this operation being effected between the thyroid cartilage and the cricoid cartilage lying immediately therebeneath. From a technical point of view, this operation is much simpler to effect than tracheotomy and can also be carried out quickly by relatively untrained personnel, and hence it is recommended for use under conditions of war where the possibility of effecting endotracheal intubation or tracheolaryngotomy do not exist. A person versed in surgery will be able to perform the operation under primitive conditions in a short period of time, with the aid of a knife or even a sliver of glass. Once the situation has been temporarily remedied, the patient can be moved to a hospital where he, or she may be tracheotomized in the relative peace and quiet of the hospital environment, whereafter the coniotomy opening can be closed.

In the case of personnel unacustomed to surgery, and particularly in the case of relatively poorely educated personnel, the performance of coniotomy can present difficulties. A plurality of comparatively complicated instruments have been proposed, for the purpose of overcoming these difficulties, and certain instruction in the use of such instruments is given by the Swedish national defence forces, for example. It can be said in general that the simpler the instruments the greater the surgical expertise is required to use the instrument. On the other hand, the more complicated the instrument is the greater is the number of manipulating sequences required, with attendant loss in time, while at the same time the more complicated instrument is heavier and more expensive than less complicated instruments.

BRIEF SUMMARY OF THE INVENTION The object of the present invention is to circumvent the drawbacks of the coniotomy instruments as known hitherto by providing an inexpensive coniotomy instrument of simple design which enables coniotomy to be performed rapidly and reliably by persons only relatively briefly instructed in the use of said instrument, thereby enabling the instrument to be used not only by medical personnel but also by ambulance drivers, nurses etc.

Basically, the coniotomy instrument according to the invention comprises a speculum portion which is adapted to be introduced into the trachea of the patient, and a knife unit the knife of which passes through the speculum portion and is adapted on application of the instrument to be advanced in such a manner that the knife point protrudes from the fore end of the speculum portion to facilitate penetration, and which, after application of the instrument, is retractable to leave a free passage for air flow through the speculum portion.

In one embodiment of the coniotomy instrument according to the invention the speculum portion comprises two separable specula blades, each at a fore end of two tongs legs, and the knife unit comprises a U- shaped portion with two resilient legs which slidably engage over the speculum portion and a knife blade which is centrally located between the legs and extends through the speculum portion.

Preferably, the resilient yoke legs are provided with abutment means to limit the depth of introduction of the instrument with the knife unit in its foremost position on the specula blades, and preferably the length of the knife should be such that with the instrument introduced to a maximum amount the point of the knife is situated essentially centrally of the trachea of a normal patient.

BRIEF DESCRIPTION OF THE DRAWINGS In the drawings wherein like reference characters indicate like or corresponding parts:

FIG. 1 shows in perspective a speculum portion of the coniotomy instrument of the present invention;

FIG. 2 shows in perspective a knife unit of the coniotomy instrument according to the invention;

FIGS. 3-5 illustrate diagrammatically how the coniotomy instrument shown in FIGS. 1 and 2 is used;

FIG. 6 shows in perspective a greatly simplified version of a two-part speculum portion of a coniotomy instrument according to the invention; and

FIG. 7 shows in perspective a knife unit which is slightly modified in relation to the knife unit shown in FIG. 2 and which is intended for use together with the speculum portion shown in FIG. 6.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS OF THE INVENTION The coniotomy instrument shown in FIGS. 1-2 comprises a speculum portion, generally shown at 10, and a knife unit, generally shown at II. The speculum portion 10 has two frustoconical specula blades l2, 13, with an opening 14 formed therebetween. The specula blades l2, 13 are formed on the front ends of two tongs legs l5, l6 capable of being moved towards and away from each other,'said legs with the illustrated embodiment being pivotally connected together at pivot point 17. The legs 15, 16 are spring biassed for movement towards each other by means of a suitable spring 18. The construction of the legs l5, 16, the pivot bearing 17 therebetween and the construction of the spring means actuating said legs, can be varied within wide limits. Further, the spring means may be omitted, if desirable. The speculum portion 10 can also be made from a wide variety of materials, even though hitherto the most suitable material is considered to be that normally used in the manufacture of conventional hospital and nursing instruments.

The knife unit 11 is preferably made of steel and is designed to straddle the specula blades 12, 13. The knife 11 has a knife blade 19 located centrally between two resilient legs 20, 21 of a U-shaped member. The legs 20, 21 are formed integrally with a bight portion 22, also referred to herein as a back plate or web member of said U-shaped member. The web member and the legs are bent from a strip-shaped blank in a manner to form wing-like grip portions 23, 24 at the junction between the web 22 and the rear ends of the legs 20, 21. In the process of manufacturing the knife unit by bending the aforementioned strip-shaped blank, abutment plates 25, 26 are formed on the front ends of the legs 20, 21, said plates 25, 26 projecting laterally outwards on respective sides of the knife blade 19. Prefer ably the knife unit 1 1 is provided with appropriate locking means which enable the knife unit 11 to be held on the specula blades 12, 12 in a predetermined position, in which the point of the knife is located inwardly of the fore ends of the specula blades 12, 13, Le. inwardly of the front end 13a of the specula blades 13 (FIG. I), for example, thereby obviating the need of providing means to protect the knife edge. One example of such locking means is illustrated in FIG. 2 in the form of a small groove 27 on the inside of the leg 20, said groove being intended to snap over the edge 28 of the rear end of the specula blade 12 when the knife unit 1 1 is mounted to the speculum portion 10. Many different types of locking arrangements suitable for the purpose envisaged are conceivable.

The manner in which the eoniotomy instrument shown in FIGS. 1 and 2 is used will now be described with reference to FIGS. 3-5: The shoulders of the patient are supported so that the patients neck is arched rearwardly. If time permits, the region where the incision is to be made is cleansed and a local anesthetic applied. The instrument is held in one hand with the thumb resting on the back plate 22 of the knife unit 11. In order not to unnecessarily obstruct vision of the knife unit in FIG. 3, the thumb is purposely shown wrongly positioned. The knife unit 11 is affixed to the speculum portion so that, as the instrument is gripped, the knife point 19 is located behind the front ends of the specula blades 12, 13, Le. in an inwardly withdrawn position. Subsequent to gripping the instrument, the thumb is pressed against the back plate 22 of the knife unit 11 to move the knife unit forwardly on the specula blades 12, 13 unit] the back plate 22 engages the rear ends of the specula blades 12, 13. The point of the knife 19 then projects a predetermined distance beyond the fore ends of the specula blades 12, 13.

The place where the incision is to be made is then localized with the index finger of the other hand and the instrument is placed at right angles to the trachea with the point of the knife 19 located as close as possible to the center line thereof. Then the knife is caused to pass through the soft portions of the throat and into the lumen of the trachea, essentially by exerting pressure with the thumb, until the abutment plates 25, 26 of the knife unit 11 engage the throat. The wing members or abutment plates 25, 26 are, of course, intended to prevent the knife blade 19 from penetrating too far into the lumen of the trachea; it will be perceived that for this reason the instrument should be so dimensioned that with the abutment plates 25, 26 abutting the throat, the point of the knife 19, with a normal" patient, should reach to the center of the trachea and that tolerances should be provided for ensuring reliable function of the instrument and safety of use with respect to adult patients whose dimensions deviate from normal.

Subsequent to the knife blade's 19 having been inserted in the aforedescribed manner, the thumb of said one hand is removed from the back plate 22 of the knife unit 11, whereafter the knife unit 11 is grasped between the thumb and index finger of the other hand and fully withdrawn (FIG. 4) while the speculum portion is retained in position. The speculum portion 10 is then widened, to enable air to pass through. In the case of emergency, the patient may be transported in this state, optionally subsequent to pivoting the speculum portion 10 so that thetongs legs lie parallel with the longitudinal direction of the trachea.

As illustrated in FIG. 5, however, it is to advantage to insert a tracheal cannula provided with a cuff, a shown generally by the reference 28A in FIG. 5. The cannula comprises in principle a bent pipe having an inflatable cuff at its inner end. If such a cannula is used, the speculum portion may be removed, of course. Subsequent to placing the cannula in position and inflating the cuff, respiration can be given to the patient, either by means of an oxygen treatment apparatus of the like or by blowing in air.

The coniotomy instrument illustrated in FIGS. 6 and 7 is a simplified embodiment of the aforedescribed instrument. The instrument shown in FIGS. 6 and 7 comprises two specula blades 29, 30 which are slightly bent and pivoted relative to each other either in the form of a fixed pivot connection (eventhough said parts are shown separated) or in the form of a loose pivot connection comprising a pivot cup and a pivot head at each edge of the specula blades 29, 30. Each of the specula blades 29, 30 has at its rear end two grip wings 31, 32 and 33, 34, respectively. The instrument shown in FIGS. 6 and 7 also has a knife unit 35, the two legs 36, 37 of which converge towards each other in a direction toward the point of the interlying knife blade 38. The dimensions of the instrument area such that the rear edges of the specula blades 29, 30, when the knife is inserted, engage in recesses 39 in the legs 36, 37. The front ends of the specula blades then lie close together, abutting the sides of the knife blade 38. Subsequent to inserting the instrument, the knife unit can be retracted until the edges of the specula blades snap into recesses or grooves 40 in the yoke legs. The yoke legs then move the rear portions of the specula blades together by pivoting around the pivot points of the specula blades, so that the opening between the front ends of the specula blades is widened to permit air to enter the trachea. The wings 31, 32, 33 and 34 can be used as holding means when the knife unit is retracted.

Having thus described my invention it will be apparent that various immaterial modifications in the same way may be made without departing from the spirit and scope of my invention.

What I claim is:

1. An instrument for use in coniotomy, comprising:

a. a speculum portion including blades jointly defining an air flow passage extending between an outer and an inner end thereof; and

b. a knife unit having a blade movably introducible through said air flow passage and so advanceable that the point of the blade can protrude from said inner end of said speculum portion;

whereby said speculum portion provides guidance for said knife unit, and whereby said air-flow passage becomes unrestricted in response to retraction of said knife unit.

2. A coniotomy instrument according to claim I in which said speculum portion comprises complemental hollow semicylindrical blades.

3. A coniotomy instrument as claimed in claim 1, wherein the knife unit is generally Ushaped and comprises a bight portion which forms a finger grip portion and two resilient legs extending from said bight portion, mutually spaced from each other, said legs being adapted to straddle said speculum portion to slidably and removably hold the knife unit thereon and between which said knife blade is centrally located.

4. A coniotomy instrument as claimed in claim 3, wherein said knife unit has latch means for holding said knife unit in a predetermined position on the speculum portion.

5. A coniotomy instrument according to claim 4 in which said latch means comprises at least one groove in one of said legs.

6. A coniotomy instrument as claimed in claim 3 wherein said resilient legs have abutment means for limiting the depth of introduction of the knife blade when the knife unit is in its most advanced position on the speculum portion, and wherein the length of the knife blade is such that the point of the knife blade will extend to substantially the center of a trachea.

7. A coniotomy instrument as claimed in claim 2 wherein the knife unit is generally U-shaped and comprises a bight portion which forms a finger grip portion and two resilient legs extending from said bight portion, mutually spaced from each other, said legs being adapted to straddle the specula blades to slidably and removably hold the knife unit thereon and between which said knife blade is centrally located.

8. A coniotomy instrument as claimed in claim 4, wherein said resilient legs have abutment means for limiting the depth of introduction of the knife blade when the knife unit is in its most advanced position on the speculum portion, and wherein the length of the knife blade is such that the point of the knife blade will extend to substantially the center of the trachea. 

1. An instrument for use in coniotomy, comprising: a. a speculum portion including blades jointly defining an air flow passage extending between an outer and an inner end thereof; and b. a knife unit having a blade movably introducible through said air flow passage and so advanceable that the point of the blade can protrude from said inner end of said speculum portion; whereby said speculum portion provides guidance for said knife unit, and whereby said air-flow passage becomes unrestricted in response to retraction of said knife unit.
 2. A coniotomy instrument according to claim 1 in which said speculum portion comprises complemental hollow semicylindrical blades.
 3. A coniotomy instrument as claimed in claim 1, wherein the knife unit is generally U-shaped and comprises a bight portion which forms a finger grip portion and two resilient legs extending from said bight portion, mutually spaced from each other, said legs being adapted to straddle said speculum portion to slidably and removably holD the knife unit thereon and between which said knife blade is centrally located.
 4. A coniotomy instrument as claimed in claim 3, wherein said knife unit has latch means for holding said knife unit in a predetermined position on the speculum portion.
 5. A coniotomy instrument according to claim 4 in which said latch means comprises at least one groove in one of said legs.
 6. A coniotomy instrument as claimed in claim 3 wherein said resilient legs have abutment means for limiting the depth of introduction of the knife blade when the knife unit is in its most advanced position on the speculum portion, and wherein the length of the knife blade is such that the point of the knife blade will extend to substantially the center of a trachea.
 7. A coniotomy instrument as claimed in claim 2 wherein the knife unit is generally U-shaped and comprises a bight portion which forms a finger grip portion and two resilient legs extending from said bight portion, mutually spaced from each other, said legs being adapted to straddle the specula blades to slidably and removably hold the knife unit thereon and between which said knife blade is centrally located.
 8. A coniotomy instrument as claimed in claim 4, wherein said resilient legs have abutment means for limiting the depth of introduction of the knife blade when the knife unit is in its most advanced position on the speculum portion, and wherein the length of the knife blade is such that the point of the knife blade will extend to substantially the center of the trachea. 